Supported by a Staged Ultrasound and ... Department of Pediatric Surgery (CM), Stanford University School of Medicine, Stanford, CA; and the Department of Internal ... Ultrasound as a single modality for the evaluation of ... concern, that of increasing medical diagnostic radiation ..... February 23â24, 2008, Orlando, FL.
An Interdisciplinary Initiative to Reduce Radiation Exposure: Evaluation of Appendicitis in a Pediatric Emergency Department With Clinical Assessment Supported by a Staged Ultrasound and Computed Tomography Pathway Naresh Ramarajan, MD, Rajesh Krishnamoorthi, MD, Richard Barth, MD, Pejman Ghanouni, MD, PhD, Claudia Mueller, MD, PhD, Bernard Dannenburg, MD, and N. Ewen Wang, MD
Abstract Objectives: In the emergency department (ED), a significant amount of radiation exposure is due to computed tomography (CT) scans performed for the diagnosis of appendicitis. Children are at increased risk of developing cancer from low-dose radiation and it is therefore desirable to utilize CT only when appropriate. Ultrasonography (US) eliminates radiation but has sensitivity inferior to that of CT. We describe an interdisciplinary initiative to use a staged US and CT pathway to maximize diagnostic accuracy while minimizing radiation exposure. Methods: This was a retrospective outcomes analysis of patients presenting after hours for suspected appendicitis at an academic children’s hospital ED over a 6-year period. The pathway established US as the initial imaging modality. CT was recommended only if US was equivocal. Clinical and pathologic outcomes from ED diagnosis and disposition, histopathology and return visits, were correlated with the US and CT. ED diagnosis and disposition, pathology, and return visits were used to determine outcome. Results: A total of 680 patients met the study criteria. A total of 407 patients (60%) followed the pathway. Two-hundred of these (49%) were managed definitively without CT. A total of 106 patients (26%) had a positive US for appendicitis; 94 (23%) had a negative US. A total of 207 patients had equivocal US with follow-up CT. A total of 144 patients went to the operating room (OR); 10 patients (7%) had negative appendectomies. One case of appendicitis was missed (
